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General NPI Number Information
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NPI Number | 1306888292
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Entity Type | Individual
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Provider Name | SABRINA ILUTZI MANN LISW
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 4233 MONTGOMERY BLVD NE SUITE 240 WEST
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-6749
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Country | US
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Telephone | 505-766-5311
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Fax | 505-883-3076
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Provider Business Mailing Address
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Address Line | 929 MADISON ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6214
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Country | US
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Telephone | 505-232-2929
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Fax | 505-765-1100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I-05014
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License Number State | NM
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